Facilitate payment review recovery efforts for its clients thereby directly increasing the department’s revenue.

Essential Duties and Responsibilities: 

• Expertise in managed care contracts and government fee schedules.
• Knowledge of current regulatory requirements to ensure prompt and accurate reimbursements.
• Utilize aging reports to monitor accounts and resolve barriers to assure timely and correct payments.
• Uses, protects, and discloses patients’ protected health information only in accordance with HITECH standards and HIPAA Privacy
• Rules and Regulations at both the State and Federal Levels.

Education and Knowledge:

• Bachelor’s degree.

Experience: 

• Minimum 10 years work experience in healthcare auditing, hospital billing, or collections.

Skills and Abilities: 

• Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written. Specifically, strong telephone communications skills are required.
• Ability to prioritize work and meet deadlines is required.
• Ability to operate most EHR systems and utilize hospital patient accounting systems is required.
• Intermediate understanding of ICD-10, HCPCS/CPT coding, and medical terminology.
• Advanced business letter writing skills which include correct use of grammar and punctuation.
• Understanding of the revenue cycle process.
• Above average analytical and critical thinking skills.
• Full understanding of hospital reimbursement and intermediate knowledge of Managed Care contracts.
• Familiar with HMO, PPO, IPA’s, and capitation.
• Understanding of EOB’s and hospital billing form’s.